title: Latency of intracranial germ cell tumors and diagnosis delay.
abstract: BACKGROUND
  Intracranial germ cell tumors (GCTs) frequently take an insidious clinical course before diagnosis. To date, clinical latency has been discussed in the context of germinoma in the suprasellar area and basal ganglia.
  
  
  OBJECTIVE
  In this study, we classified the clinical latency of intracranial GCTs into three categories and described their characteristics in order to understand the full spectrum of the phenomenon.
  
  
  METHODS
  In a cohort of 181 patients with intracranial GCTs, 17 patients had a delayed diagnosis of more than 3 months (90 days) from the initial brain magnetic resonance imaging to the definitive GCT diagnosis. Clinical records and radiological data of the patients were reviewed.
  
  
  RESULTS
  The patients with a delayed diagnosis were categorized into three groups according to their tumor location: suprasellar (nine patients), basal ganglia (six patients), and pineal (two patients). Initial symptomatology corresponded with the tumor location: central diabetes insipidus for the suprasellar group, hemiparesis for the basal ganglia group, and precocious puberty for the pineal group. The overall survival of patients with germinoma and delayed diagnosis was significantly shorter than that of patients who were diagnosed within 3 months (P = 0.002).
  
  
  CONCLUSIONS
  Clinical latency and delayed diagnosis are not restricted to germinomas in the suprasellar area and basal ganglia; they are canonical features of intracranial GCTs including pineal non-germinomatous GCTs. Early detection and proactive diagnosis of these tumors are required because diagnosis delay may negatively influence patient survival.
authors.affiliation: Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Republic of Korea.
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Phi
authors.forename: Seung-Ki
authors.initials: SK
authors.lastname: Kim
authors.forename: Young Ah
authors.initials: YA
authors.lastname: Lee
authors.forename: Choong Ho
authors.initials: CH
authors.lastname: Shin
authors.forename: Jung-Eun
authors.initials: JE
authors.lastname: Cheon
authors.forename: In-One
authors.initials: IO
authors.lastname: Kim
authors.forename: Sei Won
authors.initials: SW
authors.lastname: Yang
authors.forename: Kyu-Chang
authors.initials: KC
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000401:mortality; D002648:Child; D057210:Delayed Diagnosis / Q000009:adverse effects*; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis* / Q000401:mortality